How family physicians in Singapore recognise complexity during consultations: a qualitative study

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Abstract

Background

The prevalence of persons with complex needs in Singapore is rising. Poor understanding of what constitutes complexity impedes the identification of care gaps and development of interventions to improve care for these individuals. We aim to identify the characteristics contributing to complexity in primary care, from the Family Physicians’ (FP) perspectives.

Methods

Focus group discussions (FGDs) were conducted from January to September 2021 with experienced FPs across 14 study sites, employing a qualitative descriptive approach based on a complexity framework. Data were coded independently and categorised using thematic analysis by two independent investigators.

Results

Five FGDs were conducted with 18 FPs aged 32 to 57 years old working in different primary care settings, with a mean of 13.5 years of primary care experience. Participants emphasised the need for a unified definition of complexity. Complexity is characterised by the presence of issues spanning across two or more domains (medical, psychological, social or behavioural) that adversely impact medical care and outcomes. Persons with complex needs contrast with persons with medically difficult issues. Medical domain issues include the number of active medical problems, poor chronic disease control, treatment interactions, ill-defined symptoms, management of end-of-life conditions and functional impairment. Psychological domain issues include the presence of mental health conditions or cognitive impairment. Social domain issues include the lack of social support, competing social responsibilities and financial issues, while behavioural domain issues include a lack of trust in healthcare workers, fixed health beliefs and poor health literacy.

Conclusion

Recognising the medical, psychological, social and behavioural factors that contribute to complexity aids in discerning the diverse needs of individuals with complex needs. This underscores the need for additional support in these pertinent areas.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-024-02368-7.

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Most cited references 29

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Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.

A Tong, P SAINSBURY, J. Craig (2007)

Qualitative research explores complex phenomena encountered by clinicians, health care providers, policy makers and consumers. Although partial checklists are available, no consolidated reporting framework exists for any type of qualitative design. To develop a checklist for explicit and comprehensive reporting of qualitative studies (in depth interviews and focus groups). We performed a comprehensive search in Cochrane and Campbell Protocols, Medline, CINAHL, systematic reviews of qualitative studies, author or reviewer guidelines of major medical journals and reference lists of relevant publications for existing checklists used to assess qualitative studies. Seventy-six items from 22 checklists were compiled into a comprehensive list. All items were grouped into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. Duplicate items and those that were ambiguous, too broadly defined and impractical to assess were removed. Items most frequently included in the checklists related to sampling method, setting for data collection, method of data collection, respondent validation of findings, method of recording data, description of the derivation of themes and inclusion of supporting quotations. We grouped all items into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. The criteria included in COREQ, a 32-item checklist, can help researchers to report important aspects of the research team, study methods, context of the study, findings, analysis and interpretations.

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Whatever happened to qualitative description?

Margarete Sandelowski (2000)

The general view of descriptive research as a lower level form of inquiry has influenced some researchers conducting qualitative research to claim methods they are really not using and not to claim the method they are using: namely, qualitative description. Qualitative descriptive studies have as their goal a comprehensive summary of events in the everyday terms of those events. Researchers conducting qualitative descriptive studies stay close to their data and to the surface of words and events. Qualitative descriptive designs typically are an eclectic but reasonable combination of sampling, and data collection, analysis, and re-presentation techniques. Qualitative descriptive study is the method of choice when straight descriptions of phenomena are desired. Copyright 2000 John Wiley & Sons,

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Is Open Access

Studying complexity in health services research: desperately seeking an overdue paradigm shift

Trisha Greenhalgh, Chrysanthi Papoutsi (2018)

Complexity is much talked about but sub-optimally studied in health services research. Although the significance of the complex system as an analytic lens is increasingly recognised, many researchers are still using methods that assume a closed system in which predictive studies in general, and controlled experiments in particular, are possible and preferred. We argue that in open systems characterised by dynamically changing inter-relationships and tensions, conventional research designs predicated on linearity and predictability must be augmented by the study of how we can best deal with uncertainty, unpredictability and emergent causality. Accordingly, the study of complexity in health services and systems requires new standards of research quality, namely (for example) rich theorising, generative learning, and pragmatic adaptation to changing contexts. This framing of complexity-informed health services research provides a backdrop for a new collection of empirical studies. Each of the initial five papers in this collection illustrates, in different ways, the value of theoretically grounded, methodologically pluralistic, flexible and adaptive study designs. We propose an agenda for future research and invite researchers to contribute to this on-going series.

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Author and article information

Contributors

Jing Sheng Quek: jing_sheng_quek@nhgp.com.sg

Journal

Journal ID (nlm-ta): BMC Prim Care

Journal ID (iso-abbrev): BMC Prim Care

Title: BMC Primary Care

Publisher: BioMed Central (London )

ISSN (Electronic): 2731-4553

Publication date (Electronic): 25 April 2024

Publication date PMC-release: 25 April 2024

Publication date Collection: 2024

Volume: 25

Electronic Location Identifier: 134

Affiliations

[1 ]GRID grid.466910.c, ISNI 0000 0004 0451 6215, National Healthcare Group Polyclinics, ; 3 Fusionopolis Link, Nexus@one-north, South Tower, # 05-10, Singapore, 138543 Singapore

[2 ]GRID grid.59025.3b, ISNI 0000 0001 2224 0361, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, ; Headquarters & Clinical Sciences Building, 11 Mandalay Road, Level 18, Singapore, 308232 Singapore

[3 ]Department of Family Medicine and Continuing Care, Singapore General Hospital, ( https://ror.org/036j6sg82) Academia, 20 College Road, Singapore, 169856 Singapore

[4 ]Outram Community Hospital, 10 Hospital Boulevard, Singapore, 168582 Singapore

Article

Publisher ID: 2368

DOI: 10.1186/s12875-024-02368-7

PMC ID: 11044365

PubMed ID: 38664724

SO-VID: 6e566969-4fb5-4edd-adcd-da60a88a5544

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 29 June 2023

Date accepted : 8 April 2024

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100001349, National Medical Research Council;

Award ID: NMRC/CG/C019/2017

Custom metadata

Keywords: general practice,primary health care,complex care,multimorbidity

Data availability:

Keywords: general practice, primary health care, complex care, multimorbidity

How family physicians in Singapore recognise complexity during consultations: a qualitative study

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Abstract

Background

Methods

Results

Conclusion

Supplementary Information

Related collections

Chinese Journal of General Practice

Most cited references 29

Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.

Whatever happened to qualitative description?

Studying complexity in health services research: desperately seeking an overdue paradigm shift

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Contributors

Journal

Affiliations

Article

History

Funding

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